Interview with Dr. Eve Valera, Leading Researcher in the field of IPV and TBI
Eve Valera, PhD, is a research scientist at Massachusetts General Hospital, and an Associate Professor of Psychology in the Department of Psychiatry at Harvard Medical School. She is one of the first researchers to study domestic-violence-induced traumatic brain injuries (TBIs) in women. Her career and most recent publication were the subjects of an article by The New York Times. We also covered Dr. Valera's work in the women's health section of a previous Concussion Alliance newsletter.
Dr. Valera has had a longstanding interest in intimate partner violence (IPV). She volunteered in a women's shelter while training in clinical neuropsychology as a graduate student. The physical abuses that women in the shelter had endured made Dr. Valera wonder, "What do we know about brain injuries and these women?" When she looked, "there was absolutely nothing in the literature." It was this moment that inspired Dr. Valera to fill the gap in the research; she has since authored numerous publications, editorials, and reviews, and lectured and interviewed extensively on TBIs in survivors of IPV. In her most recent study, Dr. Valera and her team investigated the relationship between brain injury and cognitive functioning by examining "specific regions of white matter microstructure in 20 women with histories of IPV."
"Brain connectivity is very important for cognition, thinking, and behavior," Dr. Valera explained, "If that gets disrupted, you may experience a range of problems... in a concussion, axons in numerous regions throughout the brain may be damaged." This is known as diffuse axonal injury, wherein "you may not see a specific region in the brain that shows damage," but there may be many regions of unobservable damage, As a result, "the connections between the different regions of the brain may not work as well as they should." After this, a range of post-concussive symptoms may emerge, including problems with concentration, attention, and sleep.
Valera says that her study provided "some evidence," that there are neurological consequences of TBI's for women experiencing IPV similar to those seen in more studied populations such as athletes, military service members, etc. However, she cautioned, the evidence is "preliminary because we didn't have the funding to do a big study." She commented that this reality "speaks to the fact that we need to be provided more money to obtain more and better data to study these women in a way that they deserve to be studied."
"What we know about [brain injury] is almost entirely based on men. And so we're basically making a huge assumption that what we learn about men also applies to women." This "contributes to how women [with IPV-related TBI] are treated and diagnosed," as "women aren't getting the care that they need because there's not been a greater recognition that they may have sustained brain injuries."
Moreover, this inequality (amongst other sociological factors) likely inhibits women who have experienced IPV from being able to recognize the symptoms of a TBI in themselves. This, in turn, prevents them from seeking medical care, participating in TBI studies, or advocating for increased TBI research specific to women. Additionally, symptoms of TBI in victims of IPV may be misconstrued by clinicians, police, social workers, or judges as intoxication or insufficient self-care.
When asked why there is less research and medical understanding about TBIs in women and survivors of IPV, Dr. Valera suggested that many factors could perpetuate this inequality: misogyny, prejudice about IPV, the physiological effects of menstruation, and the fact that many industries with greater concussion risks predominantly include males. However, there is no evidence that justifies women's exclusion from TBI research. Dr. Valera's words point to a toxic and self-sustaining cycle in which the lack of information regarding how TBI affects women perpetuates their exclusion from TBI research. She concluded that the most plausible way to break this cycle is through education.
As funding and research on how TBI affects women (including women who have experienced IPV) increases, the educational resources will hopefully increase as well. Consequently, more people can learn how TBI affects women, and understanding and awareness of this phenomenon will hopefully improve. This, in turn, will not only create a greater demand for new research but will also enable women suffering from TBIs to receive and advocate for sufficient treatment.
Although this is indeed a challenging solution to a profound problem, Dr. Valera has shown that with perseverance, anyone — whether through research, community outreach, advocacy, or volunteerism — can help make a difference.